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General NPI Number Information
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NPI Number | 1982002002
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Entity Type | Organization
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Legal Business Name | WPD DENTAL GROUP
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Dates
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Enumeration Date | 12/06/2014
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Last Update Date | 12/06/2014
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Provider Practice Location Address
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Address Line | 3700 WILSHIRE BLVD STE 780 STE780
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City | LOS ANGELES
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State | CA
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Zip | 90010-3001
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Country | US
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Telephone | 213-380-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 WILSHIRE BLVD STE 780 STE780
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City | LOS ANGELES
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State | CA
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Zip | 90010-3001
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Country | US
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Telephone | 213-380-7900
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | DR. THOMAS J HAN
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Credential |
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Telephone | 213-380-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30416
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License Number State | CA
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